PFS implements law throwing some foreign-born patients off Medicare
By: Roy Edroso
The “Limiting Medicare Coverage of Certain Individuals” section of the proposed 2027 Medicare physician fee schedule explains how CMS will enforce a 2025 law that removes some Medicare beneficiaries from the rolls based on immigration status as soon as February 2027. If you have patients affected by this, you may not hear that their services are not covered by Medicare until after they’ve been cut — and it’s not clear that your charges on those patients will be allowed.
Monitor the maternity care coding makeover for 2027
By: Nancy Reading
Start the countdown: Beginning Jan. 1, 2027, services for antepartum care, labor management, delivery and postpartum care will be coded separately. The old global approach to billing obstetric care was intended to simplify billing, but it no longer reflects the variation and complexity of care across the phases of pregnancy.
Once upon a diagnosis: Why coding the patient’s story is vital
By: April Russell and Diane Pittman
Ever since the International Classification of Diseases (ICD) was introduced, its purpose has been clear: to capture the reason for a patient’s visit across all health care settings. As outlined in the first paragraph of the ICD-10-CM Official Guidelines for Coding and Reporting, diagnosis coding is intended to describe the patient’s condition using terminology that “includes specific diagnoses as well as symptoms, problems, and reasons for the encounter.”
Part B News Features
Ask a Part B News Expert
Question: What are some red flags associated with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other ... More
NPP Report
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Benchmark of the Week
Deciding whether to use modifier 50 (Bilateral procedure) or modifiers LT/RT (Left side/right side) requires a little forethought and sometimes homework. Still, in 2024, the most recent year of avai... More
Ask a Part B News Expert
Question: What are some red flags associated with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other ... More
NPP Report
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Benchmark of the Week
Deciding whether to use modifier 50 (Bilateral procedure) or modifiers LT/RT (Left side/right side) requires a little forethought and sometimes homework. Still, in 2024, the most recent year of avai... More
choose your feature view ► Ask Part B News & NPP Report Benchmark of the Week & Ask Part B News NPP Report & Benchmark of the Week
Part B News Blog
Aug 14, 2026
How to comment on the proposed 2027 Medicare physician fee schedule
by: Julia Kyles, CPC
Jul 27, 2026
Q&A: Level E/M encounters like an expert
by: Richard Scott
Jul 14, 2026
Breaking: Conversion factor dips as CMS proposes cuts, floats major coding updates
by: DecisionHealth staff
Tools
Update to the list of designated health services – 2026
Find the latest list of designated health services (DHS) that are subject to the Stark physician self-referral rule’s restriction on referrals. The new list went into effect Jan. 1, 2026.
Current and new descriptors for 21 CPT codes – 2026
Get a head start on revisions to codes in the E/M, cardiovascular, radiology and medicine chapters of the 2026 CPT Manual. The following chart contains the current and revised long descriptors for codes that CMS released in the proposed 2026 Medicare physician fee schedule and intends to assign an active (A) payment status
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Benchmark of the Week
Providers had little trouble taking sides among modifiers 50, LT and RT
Deciding whether to use modifier 50 (Bilateral procedure) or modifiers LT/RT (Left side/right side) requires a little forethought and sometimes homework. Still, in 2024, the most recent year of available Medicare figures, it appears providers didn’t do too badly — though some codes proved more of a challenge.
High-volume procedures show mainly fee drops under 2027 proposals
The 2027 Part B conversion factor is down between 1.2% and 1.7% depending on whether your group is working as an advanced alternative payment model (APM), according to CMS’ proposals. That will have an impact on high-volume services that are reported with frequency.
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